Why There Is Low Participation in Diabetes Prevention Programs

Only a minority of U.S. adults with prediabetes eligible to participate in a national diabetes prevention program are doing so.

Evidence-based lifestyle interventions can prevent or delay type 2 diabetes development, as demonstrated in the Diabetes Prevention Program trial.

The Diabetes Prevention Program has been translated into a year-long, group-based lifestyle intervention that forms the core of the National Diabetes Prevention Program (National DPP), established by the Centers for Disease Control and Prevention to enhance the distribution of evidence-based prevention programming into clinical and community-based settings.

The National Diabetes Prevention program is a partnership of public and private organizations working to prevent or delay type 2 diabetes. The partners work to make it easier for people with prediabetes to participate in evidence-based, affordable, and high-quality lifestyle change programs to reduce their risk of type 2 diabetes and improve their overall health, according to the CDC.

The number of programs registered under the National Diabetes Prevention Programs recognition program continues to grow and Medicare has begun covering the National DPP intervention for beneficiaries as of April 2018 (The Medicare Diabetes Prevention Program MDPP).

In a recent study in the American Journal of Preventive Medicine, nationally representative data from the 2016 National Health Interview Survey was used to identify how frequently at-risk adults are being referred to and participating in diabetes prevention programming, and explores correlates of referral, participation, and interest.

The study population consisted of adults age ≥18 years without a self-reported diagnosis of diabetes and who would likely be eligible for diabetes prevention programming based on program eligibility criteria (1) meeting National DPP 2015 BMI criteria (BMI ≥24 kg/m2 or BMI ≥22 kg/m2 if Asian) and (2) a self-reported diagnosis of prediabetes or self-reported history of gestational diabetes. In the survey, adults were asked if they had ever been referred or ever participated. Program interest was gauged on a scale of not interested, somewhat interested, and very interested.

Prevalence of self-reported referral and participation was determined, and sociodemographic correlates of referral, participation, and interest were characterized through multivariable logistic regression analyses.

The study population consisted of 2,341 adults. The majority were female (63%), white (74.6%), non-Hispanic (83.4%), and age ≥45 years (68.2%). A total of 4.2% reported ever being referred to a 12-month prevention program and only 2.4% reported ever participating in diabetes prevention programming. More than one quarter (26.2%) of eligible adults reported interest in engaging in diabetes prevention programming. In the sensitivity analysis only 1.1% of patients were referred and 1.3% participated.

In multivariable logistic regression, race was correlated with referral (black and Asian adults more likely to report referral) and age was positively correlated with participation. More than 25% of adults who were never referred or participated reported an interest in engaging in programming.

Adults with family incomes <100% of the federal poverty level were more likely to report participation than those with incomes > 200% of the federal poverty level. Increasing BMI was associated with higher odds of expressing interest, as was being black and Hispanic.

The study concluded that although more than one quarter of adults likely eligible for diabetes prevention programming express interest in participating, few are being referred and fewer still have participated. Low rates of referral and participation suggest a need to improve both program access and referral efforts. Efforts to enhance identification, recruitment, and retention of high-risk adults from clinical and community-based settings will be essential to realizing the potential of lifestyle interventions for diabetes prevention.

During a presentation at the American Association of Diabetes Educators annual meeting, Nina Brown-Ashford, deputy director for the Prevention and Population Health Group at the Center for Medicare and Medicaid Innovation, talked about ways diabetes educators can help promote the MDPP program, starting with screenings and referrals. She stated that, “If you are unable to become an MDPP supplier yourself, but you are working with beneficiaries who could benefit from this program, refer them. Screen and test your at-risk Medicare beneficiaries, and refer them to a nearby MDPP supplier.”

Practice Pearls:

The National Diabetes Prevention Program has shown to prevent or delay type 2 diabetes development. Being endorsed by the CDC has helped in implementing it in both the clinical and community setting.

Although more than a quarter of adults are eligible for the diabetes prevention program, only a few are being referred and a few participate.

Efforts to improve program access and referral are needed and diabetes educators can start by screening their at-risk patients.